COMPARISION OF LONG-TERM OUTCOMES OF PATIENTS TREATED WITH NONTHORACOTOMY AND THORACOTOMY IMPLANTABLE DEFIBRILLATORS

In 193 consecutive patients treated with implantable defibrillators at our institution, thoracotomy approaches were used in 87 patients and nonthoracotomy approaches in 106 patients. Long-term outcomes of the 2 groups were compared by the intention-to-treat analysis. Surgical mor tality (30-day mortality) rates were 5.7% in the thoracotomy group and 0% in the nonthoracotomy group. Six of 106 patients who underwent non thoracotomy implantation had a high defibrillation threshold and did n ot receive nonthoracotomy defibrillators. The duration of follow-up wa s 52 +/- 31 months in the thoracotomy group, and 23 +/- 15 months in n onthoracotomy group. Actuarial survival rates at 6 and 24 months were, respectively, 90% and 81% in nonthoracotomy patients and 89% and 80% in thoracotomy patients (p = NS). In patients with left ventricular ej ection fraction <30%, surgical mortality was 0% by the nonthoracotomy and 10% by the thoracotomy approach. Despite the 10% difference in 30- day mortality, survival rates at 6 months were 85% in nonthoracotomy p atients and 81% in thoracotomy patients. At 24 months they were 73% in nonthoracotomy patients and 74% in thoracotomy patients. Thus, this n onrandomized study suggests that white short-term survival is better i n nonthoracotomy patients than thoracotomy patients, the difference in survival diminishes quickly during the first few months and disappear s by 6 months. The results were similar in patients with severe ventri cular dysfunction. Several important implantable-cardioverter defibril lator (ICD) trials initially utilized thoracotomy ICDs. Although quest ions may be raised with regard to applicability of such a trial in the era of nonthoracotomy ICDs, this study suggests that the results of s uch ICD trials will be largely applicable to patients treated with non -thoracotomy ICDs. (C) 1996 by Excerpta Medica, Inc.